Aug 4, 2010

Doctor D Strikes Back!

It's time we make something very, very clear:

This is not a personal medical advice blog!

A lot of people just stumble across the "Ask An MD" name and start firing off questions before they read another word.
I realize you regular D Readers are not the offenders but I have to rant at somebody, so Dr. D is going to nip this in the bud right now:
I will NEVER answer diagnosis or treatment questions online!
"Luke, I am NOT your doctor!"

This isn't that I don't love you guys. It just can't happen. I challenge you to find any MD giving personal medical advice to strangers online. Nope it isn't there!

Doctor D put this info on the "Email Dr. D" page but still a majority the letters to Doctor D basically ask: "Here are my symptoms. What should I do?"

Doctor D used to write polite replies explaining that the blog is here to answer general questions about doctors and the medical system, but I really cannot diagnose you... etc.

..but as the popularity and google rank of this blog has grown Doctor D's inbox has become congested with please-treat-me-over-the-Internet emails. Abandoning all bedside manners, Dr D has begun sending snarky rebukes to the worst offenders: "Did you read the f*cking disclaimer!?!"

But that pesky medical compassion keeps D feeling sorry for all these people sending hopeless requests for help to some random medical blog!

Could These Emails Be The Symptom Of A Real Problem?
This deluge of unanswerable questions got Doctor D thinking. These people begging for answers reveal some real issues with the medical system:
  1. Sick people are desperate for answers.
  2. It is way too hard to get a doctor to talk to you. It costs too much money to get in, and even then the doc is in and out in like 5 minutes!
  3. Doctors are terrible at addressing what is really bothering patients.
"Houston, we have a problem."

Unfortunately, turning to some anonymous doc on a blog is not the solution to these problems.

Do you really want to risk getting an answer from an anonymous doc who can't examine you—some dude who may sleep under a bridge and just plays doctor online to meet chicks? Trust me: you don't want to do that!

And Doctor D won't risk his medical license making random guesses over email for people he's never laid eyes on. Giving you a harmful misdiagnosis over the internet would make Dr. D feel terrible, and it could be the blood in the water that sparks a feeding frenzy of lawyers and disciplinary boards.
Perhaps someday doctors will be more accessible, better communicators, and be able to treat you over the Internet, but this just isn't a reality right now.

Now you have to deal with regular screwed-up doctors working in a bizarre healthcare system. Yes, it sucks, but you really don't have many other options.
This is why Doctor D runs this blog: To help you navigate the tricky world of real doctors.

If He Can't Be My Doctor, What Use Is Doctor D?
Well, if you would even consider writing some anonymous blog for help then your doctor-patient relationship is probably on life support.

It may not be your fault
(doctors suck at relationships—just ask Lady D), but you will be the one who gets hurt.
Instead of desperately emailing random bloggers on the internet for answers which will likely be wrong, why don't you learn to work on with the doctors you have in your life?
Doctor D volunteers his time as a relationship counselor for your doctor-patient relationships. D isn't going be your doctor (although, he blogs anonymously so, who knows, he might actually be your doctor?), but he just might teach you how to make your own doctor useful!

So respect D's boundaries! ...And send me some questions I can work with!

What do you think?

Currently there is no way to get answers direct from a doctor online. Getting diagnosed by a doctor miles away who can't examine you is a recipe for mistakes, BUT it would be convenient.

Would you be willing to take a risk with an online doctor? Would you forgo the ability to sue if the advice harmed you? Should the standards of doctor-patient relationships change to adopt to the wired world?

By the way, if you ever sent Dr. D a forbidden e-mail now is your chance to grovel and beg for his forgiveness!


Grumpy, M.D. said...

Do you know a good neurologist who will answer questions over the internet? Or at least send me dirty MRI pictures? I can't find one like that.

Sandy said...

I find it amazing that people would even email you medical questions!ahhh...while pausing and daydreaming I see you have posted something on Euthanasia in the to go read that!

C said...

actually, i was wondering if you could prescribe some pain pills for my back....
haha jk :)

I can't believe that people actually think you can dx them without seeing them. we did learn that like 80% of the diagnosis can be gleaned from the history, but I wouldn't want a dx that could be wrong 20% of the time!
I actually have emailed my doctor questions, and he's written a script based on my email- but it was for a sinus infection, a problem i've had in the past. and I was in florida on vacation.
hopefully this post will stop the crazyness!

Amanda said...

I think what folks should consider is that if they're worried enough about their symptoms to be asking random strangers on the internet, whomever those strangers might be, just what they should do?

They likely need to go see their doctor.

That said, my GP has been incredibly difficult to see over the last few months. According to her front desk lady (god love her, she should be fired), Dr. Awesome has had "some personal stuff" going on. Yanno, either she's seeing patients or she's not. I just want her to run over the results of my bone density scan with me and a couple of other aging issues. And if she's cutting down her practice, for the love of pete just tell me and I'll go establish care with another doctor!

Really, not that difficult.


Kolle said...

Great Post! You´re on to something.

If there´s so little time for patients to phrase their worries/medical issues and doctors - for whatever reasons, it probably mostly isn´t their fault either - do not understand what they need then what good is it to see a doctor first place? I think there´s the need for a change in the system so that patients won´t have to wait for months for an appointment and will get the time they need with a doc. And I am sure this will make docs happier too. And people will go to doctors less often if their needs are addressed at the first visit.

Here in Germany we have some online forums in which a doctor answers questions regarding the treatment or other aspects of a special disease. Occasionally people will ask: I have these symptoms, could I have... They will mostly be answered go see a doc. But still, I think this is helpful. The more information the better. I don´t think it hurts. You will still need to see a real doc though.

But if you ask for wired medicine, as a patient I definitely would appreciate communication among docs on the net so they could answer each others questions. Probably this already exists without me beeing aware of it.

Queen of Optimism said...

This post is another example of why I think Doctor D and the Ask an MD blog is perfect. You not only present a call to action for those who are not respecting the boundaries but you are also looking for a reason for the phenomenon. Yes, desperation! Desperate people seek sources of hope and may be hoping that even though you say you clearly don't diagnose that you just have the answer they desperately seek. Also, desperate people don't read thoroughly.

I have seen/heard about many online doctor services. One can pay lots of $$ via paypal to consult with various MDs. Apparently one online site provides video chat primary care consults. To answer your question - I would not want to see an online doc. But in a desperate time, I may have considered it. However, I'd love if I could video chat with my PCP for smaller issues like follow-up or treatment for an atypical psoriasis flare or something else my doctor and I have a pretty good handle on - something not completely new for me or her. I'd love the convenience.

Zac said...

D, your blog cracks me up. I too am starting to suffer from the "please diagnose my fibromyalgia" emails... and worse, those emails are starting to overrun my inbox!

We need to make a stand, us medbloggers.

Anonymous said...

Wow, it sounds very frustrating to get a ton of emails from people who need help, but just not the sort of help that you are set up to provide. I know it's a complicated thing, but do you think it might help to change your blog's name?

The one way in which it seems useful to ask anonymous doctors to get involved in a medical problem is when a doctor or patient posts a confusing list of symptoms and asks any and all to guess at what the diagnosis might be. I've seen maybe two cases where some interesting new ideas were generated that way. The patient's real life doctor is the one who is responsible for confirming any such diagnosis and then setting up a treatment plan, so I hope that would limit the liability of those contributing their guesses.

Anonymous said...

I agree that perhaps more thought should have gone into choosing the name for the blog.

I am able to correspond with a former physician via e-mail occasionally and while this doctor no longer can give me medical advice, I have been greatly helped by being given examples of questions to ask (and how to ask them) of the current treating physicians.

Would you consider a 'how to talk to your doctor about all these things that are making you miserable' post?

Lorelei Armstrong said...

That's all groovy, but I gotta tell you you have the worst blog name in the world.

Aviva said...

Um, do I need to grovel? :-) I don't think I've asked for a diagnosis online here or anywhere. But I do know that I've appreciated having people who visit my blog mention their Dx and how they thought my description of my illness might be similar.

I'm blessed with a PCP who is happy to discuss any possibility since it bothers her almost as much as it bothers me that I've been sick for three years and no one can figure out what's wrong.

If she thinks it's really something worth looking into, she orders the appropriate tests. Most of the time, she ends up explaining why it's highly unlikely and not worth pursuing.

OTOH, I was a little offended when NurseK opined in a very patronizing manner on my blog that the symptoms that sent me to the ER in the middle of a June night were simple heartburn. And, while she was careful to make sure I understood she wasn't making a diagnosis, I was quite pleased when she turned out to be *totally wrong* and it was my gallbladder. I wouldn't have minded the suggestion of heartburn as the culprit if it had been given in a different manner, I think ...

Whoops, I'm rambling. Sorry. :-)

I know that if I were to ask a doctor blogger for suggestions based on my symptoms, I wouldn't consider it a diagnosis until my PCP or a specialist had confirmed it. I'm convinced, at this point, that it will require a new set of eyes (maybe a resident? maybe just a new-to-me specialist) to figure out what's wrong with me anytime in the near future.

Nina said...

In Hawaii, where there are doctor shortages to various extents on all of the islands, virtual consults are common. They take place over the phone, through email, and via webcam if available. Under BC/BS it's something like $10 for a 10 minute consult, and $45 without any insurance, and there are doctors on call 24/7. I've never used it myself, but my family finds it quite efficient for run of the mill sorts of things (kid with pink eye, sinus infection, bad poison ivy etc)

Katbird said...

I like your blog name D!

Peter said...

Now Doctor D, this is what's wrong with me..oops...just read the small print, sorry!

Ella said...

Lol. Hey, at least people don't send you their pre-med physics/o-chem/whatever homework.

Nurse K said...

I'll make it easy on everyone...If you have pain, cramping, and/or tingling in > 3 body parts, it's either (1) anxiety or (2) depression or (3) you need to just suck it up.

Anonymous said...

How come not one person suggested that these are desperate people WITHOUT health insurance and WITHOUT money to go private pay (IF they could even get an appointment without insurance). If Obama wanted to reform the health system, the first thing he'd do would be to refuse to license arrogant medical personnel.

WarmSocks said...

@NurseK - Such vitriol from someone who was in a helping profession is ignoble. I'm sorry that you've seen more than your share of the dregs of society, but there's no reason to assume that physical symptoms shouldn't be investigated and treated. You've given bad advice here.

Suppose a pedestrian gets hit by a car and is in pain. More than three body parts hurt, so by your criteria the person should just suck it up - maybe quit being so anxious or depressed.

My daughter's hips hurt. And her neck. And her knees and ankles and shoulders. She's definitely anxious about it. She's afraid that it means she has RA. The problem is in more than three places though, so I guess you're saying she should just suck it up instead of seeking treatment. Lucky for us, her physician disagrees with you.

Tingling >3 body parts. Suck it up? Stop being anxious? Could be due to an autoimmune disease, or B12 deficiency, or who knows what else. Perhaps it should be investigated by a physician to determine the cause and see if it's something that can be treated. EMG yields abnormal results, and MCV is elevated. Guess it's not depression or anxiety. It has a physical cause that can be treated.

I seriously hope nobody's looking to you for medical advice.

Nurse K said...

I hope people who have just been hit by a car aren't running to their email to inquire as to why their body parts hurt. That would be outright silly. I see an SNL sketch heralding the learned helplessness of the American populace coming on...."I got hit by a car, someone tell me why my arm is bleeding and my leg is amputated! I better check some forums and WebMD for that!"

I hope no one is going to WarmSocks for humor.

Old MD Girl said...

I told my friend who asked me about her flaking itchy groin rash that she probably had jock itch, and that she'd probably need to stick with the anti-fungals for a while until it cleared up....

Fortunately, her dermatologist agreed. But it did make me feel a bit weird.

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